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Impact of e-ASPECTS software on the performance of physicians compared to a consensus ground truth: a multi-reader,

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Artificial intelligence software for Alberta Stroke Program Early CT Score (ASPECTS) improves physician accuracy in assessing acute ischemic stroke (AIS) brain imaging. The e-ASPECTS tool enhanced performance for neurologists and neuroradiologists, leading to better stroke assessment.

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Area of Science:

  • Neuroimaging
  • Artificial Intelligence in Medicine
  • Stroke Imaging Analysis

Background:

  • The Alberta Stroke Program Early CT Score (ASPECTS) is crucial for quantifying brain injury in acute ischemic stroke (AIS) and guiding treatment.
  • e-ASPECTS software utilizes AI to automatically generate ASPECTS scores from non-contrast CT (NCCT) scans in AIS patients with middle cerebral artery (MCA) territory involvement.
  • This study evaluated the impact of e-ASPECTS on the performance of US physicians compared to a consensus ground truth.

Purpose of the Study:

  • To assess the effectiveness of the e-ASPECTS software in improving the accuracy of ASPECTS scoring by US physicians.
  • To compare physician performance with and without the assistance of the e-ASPECTS AI tool.

Main Methods:

  • A multi-reader, multi-case study design was employed.
  • Ten US board-certified neurologists and neuroradiologists scored 54 NCCT brain scans twice: once with and once without e-ASPECTS assistance, in random order.
  • Agreement with an expert consensus reference standard was evaluated using various statistical measures, including Cohen's kappa and weighted kappa.

Main Results:

  • The area under the curve (AUC) for reader performance significantly improved from 0.81 to 0.83 (p=0.028) with e-ASPECTS support.
  • Agreement with the reference standard improved, with Cohen's kappa increasing from 0.60 to 0.65 and case-based weighted Kappa improving from 0.70 to 0.81.
  • These improvements indicate enhanced accuracy in ASPECTS scoring when using the e-ASPECTS software.

Conclusions:

  • The e-ASPECTS software significantly enhances the accuracy of ASPECTS scoring for acute ischemic stroke.
  • AI-powered decision support tools like e-ASPECTS can improve the performance of even expert neurologists and neuroradiologists in interpreting brain CT scans.
  • The findings support the utility of e-ASPECTS in clinical practice for more precise stroke assessment.